Frequency, Trends and Institutional Variation in 30-Day All-Cause Mortality and Unplanned Readmissions Following Hospitalisation for Heart Failure in Australia and New Zealand

Clementine Labrosciano, Dennis Horton, Tracy Air, Rosanna Tavella, John F Beltrame, Christopher J Zeitz, Harlan M Krumholz, Robert Jt Adams, Ian A Scott, Martin Gallagher, Sadia Hossain, Saranya Hariharaputhiran, Isuru Ranasinghe

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BACKGROUND: National 30-day mortality and readmission rates after heart failure (HF) hospitalisations are a focus of US policy intervention yet have rarely been assessed in other comparable countries. We examined the frequency, trends and institutional variation in 30-day mortality and unplanned readmission rates after HF hospitalisations in Australia and New Zealand.

METHODS AND RESULTS: We included patients >18 years hospitalised with HF at all public and most private hospitals from 2010-15. The primary outcomes were the frequencies of 30-day mortality and unplanned readmissions, and the institutional risk-standardised mortality rate (RSMR) and readmission rate (RSRR) evaluated using separate cohorts. The mortality cohort included 153 592 patients (mean age 78.9 ± 11.8y,51.5% male) with 16 442 (10.7%) deaths within 30-days. The readmission cohort included 148 704 patients (mean age 78.6 ± 11.9y,51.7% male) with 33 158 (22.3%) unplanned readmission within 30-days. In 392 hospitals with at least 25 HF hospitalisations, the median RSMR was 10.7% (range 6.1%-17.3%) with 59 hospitals significantly different from the national average. Similarly, in 391 hospitals with at least 25 HF hospitalisations, the median RSRR was 22.3% (range 17.7%-27.1%) with 24 hospitals significantly different from the average. From 2010-15, the adjusted 30-day mortality (OR 0.991/month,95%CI 0.990-0.992,p < 0.01) and unplanned readmission (OR 0.998/month,95%CI 0.998-0.999,p < 0.01) rates declined.

CONCLUSION: Within 30-days of a HF hospitalisation, one in ten patients died and almost a quarter of those surviving experienced an unplanned readmission. The risk of these outcomes varied widely among hospitals suggesting disparities in HF care quality. Nevertheless, a substantial decline in 30-day mortality and a modest decline in readmissions occurred over the study period.

Original languageEnglish
JournalEuropean Journal of Heart Failure
Publication statusE-pub ahead of print - 23 Oct 2020
Externally publishedYes

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